Job Search Results for healthcare payer

Remote - Director of Payer Enrollment

About the Role:As Director of Payer Enrollment, you will play a crucial role in the leadership of ourPayer Enrollment team. Our PE Team is core to our business and is responsible for making surepayer... More enrollment execution runs smoothly. You are succeeding in this role when the PE team is:scaling efficiently, making high quality, data-driven decisions, and embracing a culture ofcontinuous process improvement.We?re looking for someone who has the ability to act tactically as well as strategically,possesses extensive work experience related to task-based workflows and quality metrics(KPI?s), as well as a demonstrated ability to drive results across a variety of workstreams. Theideal candidate is extremely comfortable conducting ongoing performance analysis and is ableto identify meaningful opportunities with both internal and external stakeholders and define andimplement subsequent action plans.The role will report directly to the Senior Director of Operations.Responsibilities:? Develop and manage Payer Enrollment leaders at various levels of professional tenure.Help your direct reports grow their skills via mentorship, 1:1s, and reviews? Support measuring and planning for the team?s performance, capacity, and growthtargets? Implement new, as well as optimize existing, tools, processes, systems, and productsthat streamline the Payor Enrollment team?s work and increase their efficiency/accuracy(i.e standardized playbooks, communication templates, training materials, resourceguides, automation features, advanced tooling, etc.)? Works with both internal and external stakeholders to resolve complex providerenrollment issues as they arise? Owning, measuring, and providing insights on renewal forecasts, customer health,customer surveys, and product usage.? Serve as the primary point of contact for customer-facing issues related to overallperformance and/or quality to effectively resolve escalations.? Manage and improve the systems that help support the team?s processes. Currentsystems include proprietary and public ones (e.g. Front, GSheets, Salesforce)? Design and conduct training regarding provider enrollment process and systems/processimprovement initiatives? Constantly learn about industry best practices and bring new ideas to the organizationabout how to drive efficiency, growth and customer outcomes? Direct ownership over Medallion?s PE function to consistently drive operationalexcellence and cost efficiency.? Certifications: Consider requiring or preferring certifications such as CPCS (CertifiedProvider Credentialing Specialist) or CPMSM (Certified Professional Medical ServicesManagement).Industry Network: Established relationships with payer representatives and industryassociations.? Crisis Management: Experience managing large-scale disruptions (payer policychanges) with resilience and minimal customer impact.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Business Systems Analyst

Insight Global is partnering with a Healthcare Start-Up based out of Nashville, TN who is looking for a Business Systems Analyst. This individual can sit remotely and requires to have strong... More experience within the Healthcare industry, specifically dealing with CMS and/or Payer data feeds. This individual must have experience with the data integration/ingestion portion, working on projects that deals with partnering with clients/vendors to define data feed exchange specifications, validate inbound feeds, provide feedback on data quality, and coordinate with cross-function teams to provide technical requirements to stage, transform, and integrate data feeds into Snowflake for analytics consumption. This position is a 6-month contract-to-hire that will convert and can pay $55-65/HR with a conversion salary of $120-135K.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote Credentialing Specialist (Privileging)

The Credentialing Specialist (Privileging) plays a critical role within the Provider Operations team, supporting the timely and accurate onboarding of healthcare providers across multiple facilities.... More This position focuses on completing primary source verifications (PSVs), preparing and submitting privileging applications, and managing reappointments in compliance with Joint Commission standards and internal service-level expectations.We?re looking for organized, detail-oriented professionals who can balance accuracy with efficiency, communicate effectively with hospitals and providers, and thrive in a high-volume, process-driven environment.Key ResponsibilitiesComplete thorough and timely primary source verifications (PSVs) for education, training, licenses, board certifications, and work history, as required by each facility.Prepare and submit initial appointment and reappointment applications to hospitals and healthcare facilities, ensuring accuracy and completeness.Communicate professionally with Medical Staff Offices (MSOs) and credentialing departments to follow up on application statuses and resolve outstanding issues.Maintain accurate and organized records of all submitted documents, verifications, and correspondence within internal systems.Adhere to facility-specific timelines and internal SLAs for credentialing and privileging processes.Monitor upcoming license, certification, and reappointment expirations, proactively initiating renewals as needed.Review provider documentation to confirm it meets all hospital, payer, and regulatory requirements.Collaborate with internal Credentialing, Licensing, and Payer Enrollment teams to ensure seamless provider onboarding.Perform other duties as assigned to support operational efficiency and compliance.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Epic Tapestry Analyst

An employer in the Southern California area is seeking two Epic Tapestry Analysts. The first Epic Tapestry Analyst will be responsible for the build aspect of Epic Tapestry, specifically designing... More the system and building components needed to enable incoming capitation functionality within the platform. (Enrollment Filer and Incoming Capitation R&R within the Tapestry module) This is a new build for the organization, and the role involves creating foundational elements to support capitation processes. Day to day duties include the following: lead the design, implementation, and maintenance of EDI workflows within Epic Tapestry, configure and support Enrollment File interfaces and Incoming Capitation R&R processes, troubleshoot and resolve EDI-related issues, including mapping errors, data discrepancies, and transmission failures, and maintain documentation of workflows, configurations, and operational procedures. They will collaborate with internal stakeholders and external payers to ensure timely and accurate data transmission, participate in testing, validation, and go-live support for new and updated interfaces, and will ensure compliance with HIPAA regulations related to health IT and data exchange. The Analyst will work alongside 2 internal resources to help them build and design the capitation functionality. This opportunity is a 6-month contract to hire opportunity. The second Epic Tapestry Analyst will be focusing on advanced build work but requires deeper technical specialization, including LPP extensions, custom cache development, custom rules implementation for configuration, and providing guidance. The key difference is that the second role demands experience implementing functionality in a live organizational environment, whereas the first role may not have that implementation background but brings extensive experience in enrollment filer build. The second Analyst position is a 6 month contract with possible extensions. Both positions will be fully remote, preferably sitting in California, but can also sit in the following states: Arizona, Illinois, Maryland, Michigan, Montana, Nevada, North Carolina, Texas, Utah, Washington & Wisconsin.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less